CT physicians call for Medicaid expansion for undocumented children
Dr. Nish Pandya, a pediatric resident at Yale New Haven Health, remembers the 10-year-old boy who came to the emergency room five times with breathing difficulties.
“His breathing improved when he received the necessary medication and treatment,” Pandya said Thursday. “He started to feel better. The look of fear started to come off of his face.”
Pandya asked the boy’s mother what type of medications he was taking at home.
“She bowed her head and said, ‘We don’t have medications. We don’t have insurance. We are undocumented,’” Pandya recalled. “This patient had been cared for in the emergency room five times in the past year. His asthma was not managed properly because his family could not afford the medication he needed to be able to breathe comfortably. His family was not able to access care or to afford health insurance.”
Pandya is one of hundreds of doctors and other health care providers across the state urging the legislature and Gov. Ned Lamont to expand Medicaid, known as HUSKY in Connecticut, to the undocumented community.
Legislators passed a law last year opening the Medicaid program to children 8 and younger, regardless of immigration status, beginning Jan. 1, 2023. The children must come from households earning up to 201% of the federal poverty level (for a family of four this year, that’s $55,778). Kids ages 8 and younger from households earning between 201% and 325% of the federal poverty level also qualify but are subject to an asset test.
Earlier this year, lawmakers tried unsuccessfully to advance a bill that would have expanded the eligibility to children 18 and younger regardless of immigration status. The measure died in the Human Services Committee.
But this month, a version of the plan was revived and tied to a new state budget proposal. The Appropriations Committee recommended opening the program to children 12 and younger. Once enrolled, those children would remain eligible for Medicaid coverage until age 19.
Children older than 12 who seek enrollment would not be covered.
While the General Assembly weighs the latest proposal, more than 400 doctors, physician assistants, nurses and other health care providers signed a letter urging legislative leaders and Lamont to expand Medicaid to all low-income residents, regardless of immigration status.
“We recognize expanding access to the undocumented immigrant population who have been excluded will be a long-term process,” they wrote in the letter. “This session we urge the Connecticut state legislature … to expand Medicaid to children 8 to 18 years of age.
“As health care providers, we recognize our responsibility to care for all patients, regardless of race, income or immigration status. Unfortunately, our state laws do not reflect that same commitment. While the uninsured rate in Connecticut is roughly 5.9%, an estimated 52% of undocumented immigrants in our state are uninsured.”
The letter was accepted by Sen. Saud Anwar, D-South Windsor, who himself is a physician, Thursday morning in front of the state Capitol. Several doctors gathered there to share stories about treating undocumented residents and the need to expand health coverage.
Dr. Heidi Zapata knows firsthand the challenges of seeking health care as an undocumented resident in the United States. She did not gain citizenship until the age of 12.
“I remember my family paying out of pocket for medicines, pediatrician visits and hospital stays,” she said. “I remember my mother saving up for the birth of my youngest sister and praying that she wouldn’t have complications, because we couldn’t afford it. That kind of stress shouldn’t be happening.”
In her role as an infectious diseases physician with the Yale School of Medicine, Zapata continues to see the toll that not having health insurance takes on many people. Some delay going to the hospital because they’re unable to cover medical bills. By the time they decide to go, “they present with infections that are uncontrolled,” she said.
Some uninsured patients have been “pushing it to the limit,” she added, while others were “too late” in seeking care.
Dr. Molly Markowitz, a pediatric hospitalist with the Yale School of Medicine and pediatrician at the Fair Haven Community Health Center in New Haven, said kids who don’t have health insurance are less likely to see a doctor and less likely to have a usual course of health care. They are more likely to postpone care or go without.
“I know that the way children live today will impact their life for years to come,” she said. “We are currently in the midst of a child mental health crisis. Yet for many undocumented children in Connecticut without insurance — who have already faced significant trauma — these serious health problems may only come to medical attention when it’s too late.”
Dr. Jemma Benson worked in an intensive care unit during the pandemic and treated several ill uninsured patients “who were more worried about how they would pay a hospital bill than the illness itself.”
“These delays in care are not limited to COVID. I’ve cared for undocumented patients who came to the hospital with advanced presentations of illnesses because they could not obtain preventive care or earlier treatment due to a lack of health insurance,” said Benson, an internal medicine physician at Yale New Haven Health.
Legislative leaders hope to send a budget package before the full House and Senate for consideration before the regular 2022 session closes on May 4.
Expanding access to health care, particularly for children, has been a priority for majority Democrats in the legislature, and COVID-19 has exacerbated the need, said Sen. Cathy Osten, a co-chair of the Appropriations Committee.
Lawmakers have recommended spending $400,000 in the next fiscal year to expand HUSKY to kids 12 and younger (beyond the current plan for kids 8 and younger). That’s roughly 1/500th of 1% of all general fund spending proposed for 2022-23.
Analysts project that opening enrollment to children ages 12 and younger would add 1,020 kids to the program next fiscal year and 2,750 by 2024.
Some advocates say the expansion, while a step in the right direction, should go farther.
“It’s a modest start,” said Jay Sicklick, deputy director of the Center for Children’s Advocacy. “But it’s not nearly as expansive and effective as it could be. I think the opportunity presents itself right now, given the state’s position, given the pandemic, to insure all children up to age 19.”
Anwar, a pulmonologist at Manchester Memorial Hospital, called on his colleagues to do more.
“If the moral argument doesn’t shake you, the financial argument is very strong as well,” he said. “The cost of health care goes up if children do not get health care for prevention and early identification and management.”
Osten said lawmakers hope to keep expanding eligibility in the coming years.
“The goal is to have all children covered,” she said. “To me, the legal status of a child should not matter if we’re treating them for a broken leg or cancer, and that’s what this is about.”